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Biochem/physiol Actions

Fludrocortisone acetate is a synthetic corticosteroid with more mineralocorticoid than glucocorticoid activity.

Veterinary Drugs and Treatments

Fludrocortisone is used in small animal medicine for the treatment of adrenocortical insufficiency (Addison’s disease). It can also be used as adjunctive therapy in hyperkalemia. Additionally, in humans, fludrocortisone has been used in saltlosing, congenital adrenogenital syndrome and in patients with severe postural hypotension.

Drug interactions

Potentially hazardous interactions with other drugs Aldesleukin: avoid concomitant use. Antibacterials: metabolism accelerated by rifamycins; metabolism possibly inhibited by erythromycin; possibly reduce isoniazid concentration. Anticoagulants: efficacy of coumarins and phenindione may be altered. Antiepileptics: metabolism accelerated by carbamazepine, fosphenytoin, phenobarbital, phenytoin and primidone. Antifungals: increased risk of hypokalaemia with amphotericin - avoid; metabolism possibly inhibited by itraconazole and ketoconazole. Antivirals: concentration possibly increased by ritonavir. Cobicistat: concentration of fludrocortisone increased. Vaccines: high dose corticosteroids can impair immune response to vaccines - avoid concomitant use with live vaccines

Metabolism

Fludrocortisone is hydrolysed to produce the nonesterified alcohol. In human volunteers, excretion through urine was about 80%, and it was concluded that about 20% were excreted by a different route. It is likely that, as for the metabolism of other steroids, excretion into the bile is balanced by re-absorption in the intestine and some part is excreted with the faeces

Definition

ChEBI: An acetate ester resulting from the formal condensation of the primary hydroxy group of fludrocortisone with acetic acid. A synthetic corticosteroid, it has glucocorticoid actions about 10 times as potent as hydrocortisone, while its mineralocorticoid acti ns are over 100 times as potent. It is used in partial replacement therapy for primary and secondary adrenocortical insufficiency in Addison's disease and for the treatment of salt-losing adrenal hyperplasia.

General Description

Fludrocortisone acetate,21-acetyloxy-9-fluoro-11β,17-dihydroxypregn-4-ene-3,20-dione, 9α-fluorohydrocortisone (Florinef Acetate), isused only for the treatment of Addison disease and for inhibitionof endogenous adrenocortical secretions. It has up to about 800 times the MC activity of hydrocortisone and about 11 times the GC activity. Its potent activity stimulated the synthesis and study of the many fluorinated steroids. Although its great salt-retaining activity limits its use to Addison disease, it has sufficient GC activity that in some cases of the disease, additional GCs need not be prescribed.